Provider Demographics
NPI:1477348001
Name:VILLANUEVA, CHANTEL ELA MAY VALLO
Entity type:Individual
Prefix:
First Name:CHANTEL ELA MAY
Middle Name:VALLO
Last Name:VILLANUEVA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 BROADWAY UNIT 639
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-5757
Mailing Address - Country:US
Mailing Address - Phone:951-306-9380
Mailing Address - Fax:
Practice Address - Street 1:1601 BROADWAY UNIT 639
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-5757
Practice Address - Country:US
Practice Address - Phone:951-306-9380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman